HIV Positive, Anal Pap Test Showed LSIL

Feb 16, 2014

Hi Dr, I'd like your advice on some HIV-related stuff. I've been positive for about 10 years, I've done great on Atripla, my labs are great. But in December 2012 my doctor did a routine anal pap on me as part of a trial she was doing for her gay male patients. My results came back showing Low-Grade Squamous Lesion, LSIL. My doctors have repeatedly told me to not worry about it, that it is just one test & that just monitoring with another pap at some point is the best course of action, but my doctors including my Colorectal Surgeon do not see any rush to do another anal pap on me. I recently had an anal fissure (lateral) which I have been using ointments for. I saw my Colorectal Doc in December & he scoped me & said for now let's just monitor things & treat the fissure with creams.

It's now February 2013, so about a year & a half since my last anal pap, should I have another one? I asked my Colorectal Doc about a High-res Anoscopy, but again he did not seem concerned or feel the need to do one. Occasionally I have some irritation & spotting (maybe due to the fissure). But I have eliminated all other risk factors like anal sex I have not had anal sex for four years or inserted any sex toys. I've tried to take excellent care of my butt.

Would just like your advice, should I have another pap, or demand a High-res anoscopy? Or wait & see what my next pap shows?

I suspect I got the HPV from receptive anal sex many years ago. Last year, I did have the vaccine, but only the first installment it made me so ill I opted not to have the second/third round of shots. Would that make a difference?

Thanks for your input!

Response from Dr. Holodniy

Unfortunately the guidelines and experts are all over the map on this, and particularly with LSIL. Some say watch and wait, others say yearly anal pap, and some even say yearly high resolution anoscopy (HRA). This is also dependent on who is paying (i.e. insurance companies, the government, private pay). To add further confusion, there is also discordance between results obtained by pap smear and those obtained by biopsy.The number of people who progress to HSIL from LSIL is low, but not zero. Probably reasonable to have a repeat anal pap, and if that still shows LSIL, to have HRA at least once.

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